LB Phoenix Bethany Home Road LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

035116 Issued in AZ

Legal business name

LB PHOENIX BETHANY HOME ROAD LLC

Doing business as

Chris Ridge Village

Practice address

6246 N 19TH Ave
Phoenix, AZ 85015-1511

Phone

(602) 433-6416

Fax

(602) 433-6458

NPI assigned

Jan 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James Michael Bausch

Title

General Manager

Phone

(602) 433-6416

Specialties & licenses 1

Addresses

Other names 1

• Chris Ridge Village Doing business as

Tax ID family

Chris Ridge Village2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Chris Ridge Village Health Care Center

  • Skilled Nursing Facility
  • Phoenix, AZ
  • NPI 1649268657
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190937600000",
    "number": "1942355219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6246 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850151511",
            "telephone_number": "602-433-6416",
            "fax_number": "602-433-6458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6246 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850151511",
            "telephone_number": "602-433-6416",
            "fax_number": "602-433-6458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LB PHOENIX BETHANY HOME ROAD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-09-28",
        "status": "A",
        "authorized_official_last_name": "BAUSCH",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "602-433-6416",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "035116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chris Ridge Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Marie Lazo
• Nicole Lazorwitz, PSYD
• Rory Lazowski
• Anna Lazzaro, FNP
• LB Dental Inc.
• LC Global Company Incorporated
• LC Global Company Incorporated
• LCS-Westminster Partnership IV LLP
• Danielle Jeanette Le Blanc, LPC, LISAC
• Le Dental P.L.C

• Skilled Nursing Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Skilled Nursing Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.